Interdisciplinary approach (neurologist and psychiatrist) in the treatment of chronic tension-type headaches

Chronic tension-type headache (CTTH) is often associated with mental disorders, especially depressive and anxiety disorders. The efficacy of involving a psychiatrist in the care for patients with CTTH has been little studied.
Objective: to evaluate the efficacy of the interdisciplinary and standard approach in the treatment of CTTH.
Material and methods. The study comprised 97 patients with CTTH and mental disorders who were randomly divided into two groups. The first (main) group (n=45) consisted of patients in whom an interdisciplinary approach was applied with a neurologist and a psychiatrist participating in the treatment. The control group (n=52) consisted of patients who were treated using the standard CTTH treatment protocol involving only a neurologist. The research protocol involved six months of treatment and observation with assessment of efficacy at two time points – 3 and 6 months after the start of treatment. The severity and baseline characteristics of pain were assessed using the visual analogue scale (VAS), pain catastrophizing scale (PCS) and the McGillas questionnaire. The Hamilton scales and the Insomnia Severity Index (ISI) were used to assess the accompanying anxiety and depressive disorders. The SF-36 questionnaire was used to assess quality of life.
Results. Positive dynamics were observed in all patient groups 3 months after the start of treatment, with patients in the main group showing a more significant decrease in the number of headache (HA) days 5.0±1.96 (in the control group 11.0±3.66; p<0.01), pain intensity according to the McGill questionnaire (7.36±4.97 and 12.93±7.49; p<0.01), PCS (8.69±7.4 and 13.7±9.03; p<0.01), concomitant affective disorders according to the Hamilton scale (7.36±4.97 and 10.11±5.42; p<0.01), improvement in sleep indicators according ISI (3.8±3.06 and 6.98±5.02; p<0.01), improved quality of life according to indicators of the SF-36 questionnaire (vital activity 60.5±11.43 and 48.75±18.68; p<0.01; pain intensity 64±13.3 and 31±20.95; p<0.01; role-playing functioning due to emotional state 70.84±15.2 and 54.49±40.71; physical functioning 90,22±11,37 и 83,17±16,66; р<0,01; social functioning 87,5±16,49 и 75±21,36; р<0,05). Similar trends were noted 6 months after initiation of therapy.
Conclusion. An interdisciplinary approach involving a psychiatrist is effective in the treatment of patients with CTTH and mental disorders.

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